Short-term effectiveness of ceftriaxone single dose in the initial treatment of acute uncomplicated pyelonephritis in women. A randomised controlled trial

Abstract

Objective: To compare the short-term effectiveness of ceftriaxone single dose followed by cefixime with a standard treatment of acute uncomplicated pyelonephritis in women.Methods: An open, prospective, and randomised trial of women with acute uncomplicated pyelonephritis was performed. Group A were given a daily intravenous dose of 1 g ceftriaxone; group B: ceftriaxone 1 g intravenous single dose followed by oral cefixime. When urine culture was received, both groups completed a 10 day treatment based in sensitivity studies. Only women with positive initial urine culture were included. After three days of treatment, clinical and bacteriological efficacy was assessed. Clinical response was classified as "cured" if acute symptoms (fever, urinary syndrome and flank pain) were settled. Bacteriological response was classified as: eradication, or no eradication. Results: Of 144 eligible patients, urine culture was positive in 54 of 72 (75%) women in group A and 51 of 72 (71%) in group B. There were no significant differences between groups in resolution of acute symptoms. Clinical cure was observed in 49 of 54 (91%) patients in the group A and in 47 of 51 (92%) patients in the group B (p = 0.68). After three days of treatment urine culture was negative for all patients. No adverse effects were observed in either of the groups. Conclusion: These data suggest that a intravenous single dose of ceftriaxone followed by oral cefixime is both effective and safe for the initial treatment of acute uncomplicated pyelonephritis in women. This regimen could be useful in managing selected patients with pyelonephritis as outpatients.

Antibiotic treatment of uncomplicated urinary tract infection in premenopausal women

“…One study [42] used a variety of antimicrobial regimens and therefore was not suitable for further evaluation. Eleven randomised studies [47][48][49][50][51][52][53][54][55][56][57][58] were published thereafter. In some of these studies acute uncomplicated pyelonephritis was treated with the same protocol as complicated UTI/pyelonephritis.…”

Management of Antibiotic-Resistant Acute Pyelonephritis

“…Sanchez et al [32] reported similar outcomes using one dose of ceftriaxone versus a 3-day course of ceftriaxone followed by oral -lactam therapy in women with uncomplicated pyelonephritis.…”

The clinical spectrum of acute ‘uncomplicated’ pyelonephritis from an emergency medicine perspective

“…In any case, microbiological negativity, a frequently chosen end-point in recent clinical trials, may be at odds with the imaging findings, as large lesions (even with abscess evolution) can coexist with negative urine cultures [22,24,[29][30][31][32][33][34].…”